Assessing suicidal thoughts and behaviors and nonsuicidal self-injury in autistic and non-autistic early adolescents using the Columbia Suicide Severity Rating Scale

Suicidal thoughts and behaviors and nonsuicidal self-injury are more common in autistic adolescents than non-autistic adolescents, per parent- and self-report. Clinician-rated measures of suicide risk (e.g. Columbia Suicide Severity Rating Scale) have not been investigated with autistic youth despite high parent–child rating discrepancies. In the present study, the Columbia Suicide Severity Rating Scale was employed to assess suicidal thoughts and behaviors and nonsuicidal self-injury in 239 early adolescents (10:0–13:9 years old) without intellectual disability, of whom 138 youth were autistic. Analyses tested diagnostic- and sex-based differences in suicidal thoughts and behaviors and nonsuicidal self-injury, and youth consistency in reporting across self- and clinician-rated measures. A greater proportion of autistic youth reported lifetime suicidal ideation (33 of 138, 23.9%) and nonsuicidal self-injury (12 of 138, 8.7%) than non-autistic youth (7 of 101, 6.9% suicidal ideation; 2 of 101, 2.0% nonsuicidal self-injury); however, there were no sex-based differences. Non-autistic youth were consistent in reporting suicidal thoughts across measures, but nearly one in five autistic youth disclosed suicidal thoughts on a self-report measure, but not on the clinician-rated Columbia Suicide Severity Rating Scale. Findings suggest that autism diagnostic status, but not sex, confers significant risk for suicidal thoughts and behaviors and nonsuicidal self-injury in early adolescents and that the Columbia Suicide Severity Rating Scale may be a useful measure of suicide risk for some autistic youth, but it may not detect all autistic youth experiencing suicidal thoughts.